Globally, we see stakeholder segments at odds with strategy, and sometimes a strategy is completely missing or often confused with tactical and operational elements. This reluctance is seen in mature democracies as well as democracies with disorders. The primary reason is a lack of alignment on a common minimum shared containment and/ or mitigation programme. In the absence of a concerted strategy, the stakeholders are bound to go into cognitive dissonance. The latter is counterproductive since it is the root cause of non-compliance, ignorance, and poor adoption.
Ideally, strategies should be across the nations, irrespective of local, state or national objectives. These strategies should be based on scientific rationale independent of political or other influences, they must be transparent and equally applicable across stakeholders.
Especially with a virus-like COVID, it is imperative to remain ahead of the wave and not trail it, as the latter has implications on lives, livelihood and the economy. Resources, including the supply of vaccines, will always see a demand-supply gap when the number of cases rises exponentially. We have seen this with the initial wave, the Delta wave, and the current Omicron wave.
Refusing to get vaccinated — anti-vaxxers and those hesitant to take the vaccine — creates a perfect milieu for the propagation of the virus. Not only those refusing to get vaccinated may suffer, but they may also pose as an ideal vehicle for the spread of the virus and the emergence of new variants. Thus, refusal to vaccinate is similar to drinking and driving. Someone may refuse to take the vaccination, but their privilege for social or professional physical interactions should also be revoked. They should be treated similarly to those evading tax. Countries like Germany have already revoked the socialisation rights of anti-vaxxers, and Singapore has asked those declining to get the vaccination to pay their medical bills. Vaccine hesitance is more a labile problem that is amenable with a rationale approach and incentivisation.
What is Vaccine Strategy?
Vaccination strategy is often misconstrued as vaccinating the vulnerable, those with comorbidities, and those above 65. However, that is a tactical decision and not a strategy. A strategy helps a nation review and identify choices to navigate operational challenges. In the case of COVID-19, the vaccination strategy would be to build herd immunity before the COVID wave reaches the target population. Thus, identifying the target population likely to be hit by the wave, the duration when the wave reaches this population, the time required to develop sizeable (herd) immunity from the vaccination will determine the success of the rollout programme.
Despite the abundance of supply, demand spike is an unavoidable phenomenon, and catering to the required doses is not simply a logistical hurdle but also poses a technical (Cold Chain) challenge. When we see similar circumstances, it is imperative to narrow down the target population at immediate risk and stagger the rollout based on those requiring the vaccination. Thus, the tactical options identify those with comorbid conditions, those above 65, and those with vulnerabilities.
COVID is a fast-moving target; hotspot containment, mitigation and staying ahead (of the wave) are thus becoming strategic imperatives. The priority group is not limited to hospital and healthcare workers but runs across essential critical infrastructures, such as electricity, water, drug supply value chain, to name a few. Thus, a comprehensive strategy can restore robustness and avoid disruption at multiple levels.
The Backbone for a National Framework
There are certain Do’s and Don’ts while building a national framework. There should be a common alignment across all the stakeholders on these Do’s and Don’ts. First, the framework should encompass an overarching national view. It should be independent of any political or commercial leaning. Most importantly, evidence-based scientific rationale should be the foundation for evaluation, decision and action. The national framework should offer accommodation for local and regional needs. Concurrently, the local and regional structure should provide a federated structure for tactical and operational requirements. The framework should provide transparency and strict adherence to the minimum common model. It should factor in the constraints and value imposed on the various stakeholders.
Dr Shashank Heda, MD, is Founder and CEO of COVIDRxExchange, a global nonprofit organisation focused on disseminating expertise and insight in the medical care of COVID. The views expressed in this article are those of the author and do not represent the stand of this publication.
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